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Registered Nurse Clinical Quality Auditor

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: June 1, 2021

Job Description:

Job Details

Clinical Auditor/Coach will specialize in auditing and performance improvement for Medical Management Nurses (Case Managers, Utilization Managers or Post Service). Candidate will develop performance metrics and evaluate performance to ensure that continuous improvement of skills and knowledge required to be successful in various nursing roles in Medical Management. The Clinical Auditor/Coach adheres to California Continuing Education Provider requirements and URAC, NCQA and DMHC training standards. Ensures RNs are current on regulations through training provided in classroom setting, one-to-one, intranet and through competency training. Often acts as a resource resolving complex case issues or interpretation of department protocols and procedures.


  • Performs audits and provides developmental coaching for clinical staff.
  • Provides clinical coaching and support to all staff to improve skills and competencies required to successfully perform work.
  • Designs, implements, evaluates and improves audit criteria and training courses/programs to meet clinical needs of Medical Management nurses.
  • May independently represent the training department in Medical Management work re-design, process changes and software implementation
  • Conducts/facilitates effective presentations relating to Medical Management processes and/or training for internal or external customers.
  • Acts as a resource for the training and auditing team.

Knowledge, Education, and Experience

  • Ability to provide direction and support to staff.
  • Current California RN license. At least 4 years training and/or auditing experience and at least 1 year experience in managed care or similar complex healthcare environment.
  • Bachelors or advanced degree preferred.
  • Certified Case Manager (CCM ) &/or Certified Professional in Learning and Performance (CPLP) preferred.
  • Demonstrated skill with coordination of complex training requests and large classroom environments.
  • Meets or exceeds Sr. minimum experience requirements.
  • Familiarity of Motivational Interviewing theory and practice.
  • Strong organizational and/or project management skills to coordinate departmental projects & to perform multiple projects or tasks simultaneously.
  • Functions independently in classroom environment and lifecycle development activities.
  • Subject matter expert w/capability to effectively train/audit all lines of business and 8 of the 10 clinical processes.
  • Current California RN license & 7 years related experience and/or training, or equivalent combination.
  • CCM, IQCI, CPLP preferred.
  • QA and regular performance audits.
  • Training and mentoring.

Additional Information

  • About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
  • Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

  • EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
  • Requisition ID: 210014P
  • Posting Date: Mar 24, 2021
  • Schedule: Full-time

Keywords: Blue Shield of California, Rancho Cordova , Registered Nurse Clinical Quality Auditor, Other , Rancho Cordova, California

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